Active NPI
Phillip G Doerner, MD
- Anesthesiology Physician
- Oklahoma City, OK
National Provider Identifier
1619937406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 14750
- Practice address
- 3100 SW 89TH St
Oklahoma City, OK 73159-7900 - Phone
- (405) 602-8100
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 14750 | OK | Primary |
Addresses
Primary practice location
3100 SW 89TH St
Oklahoma City, OK 73159-7900
Mailing address
PO Box 1547
Sedalia, MO 65302-1547
Phone (660) 826-5960
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100827590A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14750 | OK | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501200000000",
"number": "1619937406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1547",
"city": "SEDALIA",
"state": "MO",
"postal_code": "653021547",
"telephone_number": "660-826-5960",
"fax_number": "660-826-4852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 SW 89TH ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731597900",
"telephone_number": "405-602-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOERNER",
"first_name": "PHILLIP",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2017-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OK",
"license": "14750",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100827590A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.